=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134825771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE EILEEN JOYCE PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2023
-----------------------------------------------------
Last Update Date | 02/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2553 MAIN ROAD
-----------------------------------------------------
City | EAST PEMBROKE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-813-3608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 256
-----------------------------------------------------
City | EAST PEMBROKE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14056-0256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-813-3608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 404576
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------